Voice disorders

Organic voice disorders

Voice disturbances in chronic laryngitis are caused by damage to the neuromuscular apparatus of the larynx and non-closure of the vocal folds.
Voice defect is expressed by loss of normal sound, severe fatigue, and sometimes the inability to perform vocal tasks. Characterized by unpleasant subjective sensations in the throat - scratching, soreness, rawness, sensation of a “lump”, pain, pressure. In the case of peripheral paralysis and paresis of the larynx, the voice may be completely absent or have a hoarse sound. Voice impairment is accompanied by severe speech fatigue, reflex cough, choking, and respiratory distress. Discoordination of phonation and breathing significantly aggravates the defect.

Voice disorders associated with benign and malignant tumors of the larynx develop gradually as the tumors grow. After any, even gentle, surgical intervention on the larynx, transient voice disturbances occur. When the larynx is removed, a person completely loses his voice; in this case, the respiratory function is sharply impaired, since the trachea and pharynx are separated.

With central paresis and paralysis of the larynx, observed with dysarthria and anarthria, the voice becomes weak, quiet, intermittent, dull, monotonous, often with a nasal tint.

Organic voice disorders that occur in a young child are accompanied by a lag in speech development, a delay in the accumulation of vocabulary and the development of grammatical structures, impaired sound pronunciation, communication difficulties and limited social contacts. Voice disorders that develop in adulthood may lead to professional unsuitability.

Functional voice disorders

Being a peripheral functional voice disorder, phonasthenia is an occupational “disease” of people in voice-speech professions. Manifestations of phonasthenia include the inability to arbitrarily regulate the sound of the voice (strengthen or weaken), interruptions (misfires) and rapid fatigue of the voice, hoarseness. In the acute period of phonation, the voice may disappear completely. In most cases, phonasthenia does not require treatment; The voice recovers on its own after a period of rest.

With hypotonic dysphonia, due to paresis of the internal muscles of the larynx, non-closure of the vocal folds develops, which is manifested by hoarseness, vocal fatigue, pain in the muscles of the neck and back of the head; in severe cases, only whispered speech is possible. With hypertonic dysphonia, caused by tonic spasm of the laryngeal muscles, the voice is distorted, becomes dull, rough; in aphonia – does not occur at all.

A pathological mutation can be expressed in the preservation of a high-pitched voice after puberty, voice instability (alternating low and high tones), dysphonic sound, etc.

Functional voice disorder of a central nature (hysterical mutism, psychogenic aphonia) is characterized by a complete simultaneous loss of voice, the inability to whisper speech, but at the same time preserved sonorous laughter and cough. An important differential feature is the variability of the form of non-closure of the vocal folds. The course of psychogenic voice disorder is long-term, and repeated relapses are possible after voice restoration.

Types of voice disorders

Voice disorders are divided into organic and functional. This is important for the choice of specialized (phoniatric) treatment methods and speech therapy techniques.

Functional disorders are associated with temporary changes in the larynx, so in the process of training a normal-sounding voice is restored.

In case of organic disorders, persistent changes in the structure of the larynx, vocal folds and supernatant are observed. During classes, the speech therapist manages to restore the communicative function of the voice, but the quality of the voice (strength, pitch, timbre) differs significantly from the norm.

Functional disorders

Functional voice disorders are less common in children than in adults.

In children, the most common disorder is the so-called spasmodic dysphonia, which occurs due to vocal strain. The onset of development of dysphonia is observed at approximately 5 years of age, and the highest frequency is observed in children aged 8 to 10 years. Dysphonia often occurs in children with increased activity who like to speak loudly and scream. Typically, a child with dysphonia has a clear and clear voice in the morning, but hoarseness gradually increases in the evening.

As a rule, along with vocal strain when screaming, children experience chronic tonsillitis, adenoids, and laryngitis. A sudden voice disorder may occur in a child due to an allergic disease. The occurrence of dysphonia can also be facilitated by unhygienic phonation conditions - dust, smoke, noise in the room, etc.

In children, organic changes appear in the larynx - nodules in the middle of the vocal fold (the so-called “screamer’s nodules”). They are most often observed in boys aged 5 to 10 years.

The main reason for their appearance is overload of the fragile vocal apparatus in combination with the characterological characteristics of children and the incorrect attitude of parents and educators to voice development. Along with this, phonation breathing is disrupted - it becomes shallow, tense and weak. The voice is characterized by persistent hoarseness.

Children may also experience functional aphonia (lack of voice). Its characteristic feature is the instability of pathological changes in the larynx and the possibility of the appearance of a sonorous voice when coughing. In these cases, the voice is restored under the influence of treatment and special exercises. Functional disorders also include a pathological mutation of the voice - a physiological change in the voice during adolescence, accompanied by a number of pathological changes in the voice and in the voice-forming apparatus.

Treatment

A course of phonopedic classes with a phonopedist is aimed at restoring the tone of the vocal folds and removing “clamps” from the larynx. A phonopedic therapist helps to understand the causes of incorrect voice guidance, develop a personal course of phonopedia, and restore voice function. This comprehensive approach allows you to restore your voice and prevent recurrence of laryngeal disease in the future.

We should not forget that ignoring a problem with the voice will lead to the consolidation of incorrect phonation, deterioration of vocal function, and may become the beginning of the emergence of organic pathology of the vocal apparatus - laryngitis, laryngeal tumors.

Causes of voice loss: why pathology is formed

The normal state of a person is the ability to produce sounds, speak words and sentences loudly and clearly. However, in some cases, aphonia may develop in adults and children - the absence of a sonorous, normal voice, although the ability to whisper is preserved.

The most common causes of voice loss are colds, acute tracheitis, acute respiratory infections, sore throats and any processes associated with inflammation and swelling of the pharynx, larynx or vocal cords. In addition, the voice may be “lost” in the following cases:

congenital malformations of the larynx;
ligament damage (musicians, teachers, lecturers);
exposure of ligaments to very high or low temperatures;
foreign bodies entering the respiratory tract or vocal apparatus;
toxic effects, for example, laryngeal spasm may occur due to polluted air;
psychological trauma: nervous, frightened;
paralysis or paresis of the larynx and vocal folds;
formation of a tumor in the organs of the speech apparatus;
pneumonia, with severe bronzitis, chronic laryngitis;
prolonged and frequent screaming and screeching (that is, improper “use” of the speech apparatus).

In addition, there is a high probability of voice loss after operations involving effects on the organs of the vocal apparatus, during tracheal intubation, as well as in the presence of certain lung lesions.

Diagnosis of hypotonic dysphonia

When examining a patient, a phoniatrist sees during phonation a glottis of different sizes and locations - in the middle, posterior parts of the vocal folds, or even along the entire length. This means that the vocal folds do not close together. And because of this, the air does not linger in the subglottic space, a full-fledged strong voice is not formed, the voice is weak, the voice is quiet, the voice trembles when singing, it is impossible to talk for a long time. The severity of hoarseness may vary, the strength of the voice decreases, vocal fatigue appears, and the timbre changes. This makes it difficult for vocal educators, teachers, coaches, the training of future singers, and the performance of professional duties for everyone.

Corrective work for voice disorders; methodological development in speech therapy

Corrective work for voice disorders.

Work on the voice affects all its qualities: strength, height, duration, timbre and their changes in the speech process. Corrective actions should be based on the results of the examination. The voice examination is carried out together with the main one, at the beginning of the year. The child is asked to perform a series of exercises.

Duration. Pronounce a short and a long sound U - UUUUUU (take into account how long the child can pull out the sound and how the duration differs).
Force. You need to pronounce a combination of sounds, a word or a phrase quietly, loudly and in a whisper (differences between volumes are taken into account).
Voice pitch. Imitate the pronunciation. A cow moos - MU, a calf - MU (the difference is taken into account).
Voice modulation. The plane approaches and flies away UUUUUUUUUUUUUU (the ability to raise and lower your voice is taken into account).

Corrective work is based on the principles:

Communication with medical specialists.
Consistency, systematicity.
The work begins with intact voice functions.
Each exercise is carried out until the child has completely mastered it.
All exercises are selected from simple to complex.
Patience and a friendly attitude towards children.
Voice correction classes should include articulation and breathing exercises and physical therapy.

All work is carried out after consultation with an ENT doctor. It should be remembered that the strength of the voice is individual and develops gradually. When developing the ability to pronounce vowel sounds, syllables, words and phrases in a loud voice, you need to make sure that there is no excessive forcing of the sound or unpleasant sensations. When strengthening their voice, children should not raise it, as this can lead to a breakdown in their voice. The pitch of the voice is individual: some children have a lower fundamental tone, others have a higher one. In the course of working on the timbre, strength, and pitch of the voice, the basis is created for the development of the intonation and expressive side of speech. For correctional classes, subgroups of children based on similar disorders can be formed.

Exercises to activate the muscles of the velum.

When correcting the voice, activation of the muscles of the velum, soft palate, relaxation of the tone of the vocal cords, and muscles of the lower jaw are of great importance. For any voice disorders, the following work must be done:

1. Activation of the velum:

vertical stroking, kneading, jerking movements with the thumb in the direction from the upper incisors to the small tongue.
transverse movements at the border of the hard and soft palate; when performing these movements, the muscle of the posterior pharyngeal wall is also activated.
when pronouncing the sound [A] - rubbing movements across the soft palate from the upper incisors to the small tongue (the mouth is wide open, irritation comes from pronunciation).
fast, short pronunciation of the sound [A] with simultaneous jerking movements across the soft palate with the thumb.

2. Gymnastics of the soft palate:

coughing;
yawn;
swallowing water in small portions;
imitation of mouth rinsing.

3. Exercises to relax the vocal folds:

simultaneously with turning your head to the left - to the right, pronounce the sound track from the vowels i-e-o-u-a-y.

4. Gymnastics of the lower jaw:

opening and closing the mouth, imitation of chewing;
opening the mouth with the simultaneous movement of the tongue forward, then this exercise with the pronunciation of the sound [A], first quietly, then loudly and with force (the wider the mouth, the narrower the pharynx, the narrower the pharynx, the more active the muscles of the back wall of the pharynx).

Insufficient velopharyngeal closure is the cause of nasality in speech, therefore exercises to activate the muscles of the lower jaw, soft palate and posterior pharyngeal wall are interrelated.

Further correctional work is carried out sequentially, all exercises are carried out in order and practiced. Once mastered, you can move on to the next one. Most often, all components of the voice are impaired, so we suggest exercises first to develop the timbre of the voice, then the duration, strength, height and intonation expressiveness of speech; they can also be alternated.

Development of voice timbre.

Exercises to develop timbre and duration develop sonority, reduce tension in the muscles of the neck and larynx, and jaw tightness. They give speech evenness, flexibility and endurance of the voice, i.e. the ability to withstand prolonged vocal load without losing sound quality.

Exercise 1

I.p. standing, feet shoulder-width apart, hands clasped above your head. Inhale through your nose, bending back slightly. Leaning forward, exhale slowly. At the same time, pronounce a new vowel each time: “a”, “o”, “u”, “s”, “e”.

"A" - hands up.
“O” - hands in a ring in front of you.
“U” - hands like a mouthpiece.
“Y” - hands in an oval in front.
“E” - hands in an oval behind.

Exercise 2

I.p. standing, place your hands on your chest. Leaning forward, as you exhale, pronounce several vowel sounds, bringing the duration of the exhalation to 7-10 seconds.

Exercise 3.

As you exhale, chant words, proverbs, sayings that are rich in vowel sounds that require a wide opening of the mouth.

We will go into the forest (Children raise their arms to the sides and up) We will call the children: “Ay! Ay! " (They make a mouthpiece with their hands) I took the bow and shouted: “Eh! Now I’ll surprise everyone!” I pulled my bow tighter, but suddenly the arrow got stuck! And everyone around said: “E__ e__ e__ e.” Tarlapan E

Exercise 4.

While standing or sitting, take a short breath through your nose. Exhaling, with your mouth closed, without tension, pronounce “m” or “n” with a questioning intonation, while achieving a feeling of light vibration in the area of the nose and upper lip.

Exercise 5.

Take a deep breath. On one exhalation, pronounce first briefly and then protractedly one of the open syllables:

“Mo-moo, moo-moo.” Early in the morning the Shepherd: “Turu-ru-ru!” And the cows started mooing after him: “Moo-muuu.” I. Tokmakova

Development of duration and stability of the sound of the fundamental tone of the voice.

Exercise 1.

Smoothly join your hands in a rounded manner in front of you (or above your head) and say protractedly: “O.” Sharply lower your joined hands down and say briefly: “Oh.” The same with syllables and words.

Exercise 2.

Smoothly spread your arms to the sides and say protractedly: “A.” Then join your straight arms in front of your chest and say: “U.” Sharply spread your hands and briefly say: “A”, connect - “U”.

Exercise 3.

Standing, spread your arms to the sides, swinging them (“the plane is flying”), and say protractedly: “B.” Sharply lower your hands down, sit down and say briefly: “B” (“the plane has landed”).

Development of voice power.

The ability to change the strength of the voice is one of its important means of expression. It is necessary to teach the child to speak loudly, but not “loudly”, clearly, gradually changing the strength of the voice - from loud pronunciation to medium and quiet, and vice versa.

Exercise 1.

Standing, spread your lowered arms to the sides and quietly say: “Ah.” Raise your arms to the sides from your chest, a little louder: “Ah.” Hands above your head, loudly: “Ah.” Same with other vowels.

Exercise 2.

Walk in place (walk in a circle) to the sound of a tambourine or drum: loud beats - walk, raising your legs high and loudly pronouncing: “top-top-top”; quieter beats - walk normally, saying: “top-top-top” in a voice conversational volume, quiet beats - slightly raise your legs and pronounce sound combinations quietly.

We clap our hands: “Clap-clap-clap.” We stomp our feet: “Top-tomp-tomp.”

Exercise 3.

While sitting or standing, count to 5 (10), with a gradual decrease in the strength of your voice (from loud to quiet), imagining that you are going down from the top floor to the basement (and vice versa).

Exercise 4.

Reading a poem, changing the strength of your voice with each verse. The semantic content of each verse corresponds to the recommended change in voice strength, which facilitates its correct presentation.

There was silence, silence, silence... (Almost no voice, just articulation). Suddenly it was replaced by a roar of thunder. (Whispers) And now it’s raining quietly - do you hear? (Voice at conversational volume). It dribbled, it dripped, it dribbled across the roof. He'll probably start drumming now. Already drumming. It's already drumming! (very loud) A. Shibaev

Development of vocal range

Changing the pitch of the voice is one of the most significant means of expressiveness. It creates the melody of tone, that is, the movement of the voice up and down. The melody of tone colors the sounding word with various shades of feeling and thought. Exercises are offered to change pitch modulation, which contribute to the development of intonation, flexibility and gradually expand the volume of the voice.

Exercise 1.

Standing, spread your lowered arms to the sides and say in a low voice: “Oh.” Hands to the chest, in a medium, normal voice: “Oh.” Hands up, high voice: “Oh.” Repeat the same with other vowels and in combinations with consonants like “ta-to-tu”.

Exercise 2.

While standing, slowly raise your arms up and then lower them, saying “U.....tu...”, etc. at first in a low voice, which gradually rises and then falls. The same goes for other consonants.

Game "Airplane".

The plane is taking off. (They say in a low voice, hands down: “U”). The plane is flying, its engine is humming. (In a high voice, arms to the sides: “U”); The plane lands. (In a low voice, hands down, crouching: “Uh”).

Exercise 3.

Reading poetic material associated with changes in voice pitch.

The train flies at full speed: - Wow! Wow! Wow! (Say in a high voice, making circular movements with your arms bent at the elbows). The diesel locomotive hummed: “Uh-uh-uh.” (In a low voice, they stop and honk). He took the kids home: “Doo-doo-doo.” (They squat).

"Oh! - exclaimed the perch, - I was hooked. Spoken in a high voice. Som grumbled angrily: “I got caught because of a prank.” In a low voice.F. Bobylev

Little feet. Running along the path: Top! Top! Top! (In a high-pitched voice while lightly rhythmically tapping with two fingers). Big legs - Walking along the road: Top! Top! Top! (In a low voice, the pace of speech is slow, fingers are heavily knocking on the table).

Development of intonation and expressive aspects of speech.

The development of intonation gives speech an emotional coloring, organizes the semantic side of speech with the help of logical intonation, reflects the meaning of words, and has the power of influence on the listener. Therefore, dramatizations of Russian folk tales, poems with imitation of heroes, and dialogues with different intonations are offered.

Exercise 1.

Imitation of various emotional states, accompanied by body movements and facial expressions.

Pain: “Ah-ah, I have a headache” - hands at the head, eyebrows furrowed, face depicting suffering.

Joy: “Ah-ah! Hooray! My head doesn’t hurt, mom is here” - hands up, eyes wide open, mouth smiling.

Question: “Huh? Where? Who's there? Mother?" - arms to the sides, elbows bent, eyebrows raised, mouth slightly open.

Request: “Oh, ah-ah, give me, help me, come to me, mom” - hands forward, eyebrows slightly knitted.

Fatigue: “Oh, ah, oh, ah, I’m tired” - arms are lowered down, facial muscles are relaxed.

Exercise 2.

Game-exercise for developing the expressiveness of facial expressions, movements, voice “Tell and show.” Based on the pictures, you are asked to name antonym words, accompanying the speech with expressive gestures and facial expressions: cheerful - sad, angry - kind, surprised - indifferent.

Exercise 3.

Playing off the habits of various animals, the characteristic features of people (image of an angry big dog, an affectionate cunning cat, a surprised mother, etc.).

Exercise 4.

Emotional coloring of paintings like: “Well done!”, “Ay-ay-ay, bad!” etc.

Exercise 5.

Expressive reading of poems and rhymes, rich in intonation-colored material.

Those who are overcome by fear say the word “Ah!” Those who encounter trouble say the word “Oh!” Those who fall behind their friends say the word “Hey!” Whoever takes their breath away, say the word “Wow!”.A. Tetyavkin

Exercise 6.

Dramatization of poems and fairy tales accessible to children (“Kolobok”, “Teremok”, “Three Bears”, etc.).

Games for voice development.

Games are a logical continuation of the exercises and are aimed at developing the cohesion of the children's team, children's attention, sensitivity to audio (auditory) perception and adequate communication response. During these games, children master the tempo-rhythmic (intonation, pause system) and dynamic (voice volume control) characteristics of spoken speech, and learn to control their vocal apparatus.

Game "Tape recorder"

To play the game you need to make or draw cards - symbols

Option 1: Playback

Before starting the game, children need to demonstrate the operation of audio equipment so that children can see and hear how the tape recorder accurately reproduces the speech recorded on film.

The main task of the participants in the game is to reproduce as accurately as possible what the driver said.

Option 2. “Regulation”

Demonstrate to children the capabilities of a tape recorder: adjusting the volume and speed of recording playback. Using symbolic images, you need to respond correctly to commands. Children reproduce a speech pattern based on a specific symbol.

Option 3. “On the contrary”

Participants are divided into two teams or pairs. One team receives a picture with a symbol and the task of reproducing something in accordance with it. The task of others is with the opposite sound. Whisper - loudly, quickly - syllable by syllable...

Option 4. “Phonogram”

Before starting the game, you can invite children to listen to several recordings from the “Voices of Native Nature” series and come up with appropriate names for them. An airplane taking off, a blizzard, rain, rustling leaves, a train... Invite the children to make some noise themselves (in the forest, in a swamp, in the kitchen, a vacuum cleaner, birds chirping). Record it on a tape recorder. It is very interesting.

In these games you can sing, play musical instruments, tell poems, fairy tales, stories, play sounds, words, phrases, sentences behind the leader, independently or together. You can also work with pure tongue twisters, tongue twisters, proverbs, sayings, and onomatopoeias.

The speech of an adult is of great importance in the development of the voice. Most often, children fail to complete the exercises the first time, although after the teacher shows them, the child copes with the task. It follows from this that the teacher’s speech should be beautiful, correct, clear, bright and friendly. Children strive to be like adults, and they have a desire to correct their speech defects. It is important that children are surrounded by smart teachers with correct speech worthy of imitation.

With proper organization of voice correction work, the following results will be noticeable:

The children's voice became clearer and louder, acquired modulation, sufficient volume, and sonority. He became lighter and stronger in the process of everyday verbal communication. Children are free to control their vocal capabilities without strain.
The activity of the articulatory apparatus intensified, movements became dexterous and precise. Defective sounds are easier to install and automate.
Voice improvements have a positive effect on the emotional sphere and mood. Children become more active, cheerful, and feel like full members of the children's team. Improving the voice has a positive effect on the child’s character and promotes normal communication with others.
Speech diaphragmatic breathing was normalized.
Voice correction has a positive effect on the emotional and volitional sphere, there is confidence in one’s strengths and a desire to continue working to improve the quality of the voice.
The use of techniques to improve voice quality requires less effort on the part of the speech therapist and the child, and the duration of speech therapy work is reduced.

Bibliography.

Almazova E.S. Speech therapy work on voice restoration in children. M., 2005
Belosheyeva A.A., Golysheva V.A., Nevolina G.L., Okuneva G.Yu. Nervous and mental disorders in children. Speech disorders in children. Perm, 1999
Miklyaeva N.V. Phonetic and speech therapy rhythms in preschool educational institutions. M., 2004
Pozhilenko E.A. Methodological recommendations for producing sounds in children. S. – P., 2006
Journal "Speech therapist" 2004, No. 1, p. 17.
Journal "Speech therapist" 2005, No. 4, p. 94

Classification of voice disorders

In medicine, voice disorders are divided according to the degree of manifestation of the disorder into:

Dysphonia is a disorder in which the strength of the voice decreases, its color and pitch change. With dysphonia, the voice becomes hoarse, lowers, and becomes hoarse;
aphonia is a disorder during which the voice disappears completely. With aphonia, a person can only whisper.

According to the mechanism of development, these disorders are divided into:

organic;
functional.

Based on the location of lesions of the vocal apparatus, voice disorders are:

central - voice disorder resulting from pathological processes occurring in the middle of the vocal apparatus;
peripheral - pathological changes occur in the peripheral part of the vocal apparatus.

A child's voice is the subtle strings of your child's soul

At an appointment with a phoniatrist

A child's voice is the subtle strings of your child's soul

“My child has constant hoarseness, although he does not have a cold or have any chronic diseases. Please advise what to do and which specialist to contact.”

Natalya Zaitseva, Rostov

Parents are increasingly asking questions about why our children have voice problems and how to solve these problems. And the number of children with altered timbre - from mild hoarseness-hypernasality, to pronounced disturbances in the tone and strength of the voice - is constantly growing. What is the reason for this and how can I help the child in such cases? These questions are answered today by the leading specialist of the OKDC, otorhinolaryngologist and phoniatrist of the highest category, Nadezhda Filonenko.

Be careful - voice!

It must be admitted that vocal overload associated with raising a child in preschool institutions, classes in vocal and choral groups, where there are often no experienced teachers, environmental and social problems lead to the fact that the doctor has to deal with children suffering from diseases of the vocal apparatus more often.

Unfortunately, both teachers and parents themselves rarely remember that children’s respiratory organs differ in some ways. The nasal passages, pharynx, larynx, trachea and bronchi in a child are relatively narrow and covered with a delicate mucous membrane, the muscle tissue of these organs is poorly developed, the cartilage of the larynx is soft and easily compressed. Since the chest in children is raised, and the ribs cannot fall as low when breathing as in adults, children are not able to take deep breaths, which, of course, limits the strength of the voice and the duration of the sound.

Our child is growing and constantly changing. But this process occurs unevenly. This also applies to the vocal apparatus. If the growth of the nasopharynx and paranasal sinuses mainly ends by the period of puberty, by 12-14 years, then all other organs complete their growth only with the end of this period - conditionally by 18-19 years.

Why is the “silver” lost?

Every 2-3 years, a child’s voice changes its quality. From “silver” with a sound range of 5-6 notes, it becomes rich, acquires a full sound, a “metallic” tint. Its range gradually increases; in adolescents it can be equal to two octaves.

As a rule, the formation of the voice develops by imitation before the age of 7, and depends on what the voice and manners of its use were like among those around them - parents, teachers, educators, peers. Process

Voice development in children goes through 4 periods:

Preschool (6-7 years old)
Pre-mutation (7-12 years)
Mutation (12-15 years)
Post-mutation (15-19 years)

The preschool period is characterized by the fact that the child’s larynx has a rather high position compared to adults. In addition, in all parts of the larynx there is a large number of mucous glands, lymphatic and connective tissue, they seem to replace some of the missing internal muscles of the larynx.

The vocal muscles, located in the thickness of the vocal folds, begin to form in the form of separate bundles from the age of 5 and develop by approximately 11-12 years, that is, already in the second period - pre-mutation. Therefore, in children under 10 years of age, a falsetto mechanism of voice formation is observed. Their vocal folds never close completely, forming a gap in the form of a triangle or linear shape. This is falsetto.

By the age of 11-12, the vocal muscle begins to become independent and take part in the process of voice formation. At this age, another phonation mechanism appears—thoracic. At the lower tones of the range, a chesty voice appears, while at high tones the falsetto still remains. At the same time, in low tones the vocal folds close completely; in high tones there is a narrow linear gap characteristic of falsetto.

Then comes the mutation itself - the period of voice change, a physiological state associated with changes in the function of the larynx and the entire body during puberty. Usually this period passes unnoticed by the child and his parents and is not accompanied by any disturbances if the process proceeds slowly and gradually. In the acute course of the mutation, sudden changes in the voice occur - breakdowns, the appearance of low sounds, a sudden “jumping into a fistula”. Such changes are noticeable for both the child and his parents. Singing children especially feel these symptoms. In some teenagers, the voice becomes rough, hoarse, without modulation.

Difficulties of adolescence

The mutation occurs at the age of 12-15 years. Moreover, this is typical not only for boys, but also for girls. Although in girls, voice changes usually occur smoothly, without jumps, without painful sensations in the larynx. During this period, secondary sexual characteristics appear. The child is extremely nervous. Pronounced anatomical changes occur in the larynx: the cartilages of the larynx increase in size (in boys in the longitudinal direction, and in girls in the transverse direction). There is rapid growth of the vocal folds; during the mutation period, their length in boys increases by 1.5 times, and in girls by only one third.

The teenager's voice drops almost an octave. Its timbre also changes: the voice goes from alto to tenor, baritone or bass. In girls, there is an expansion of the range towards both low and high frequencies.

The mutation period usually lasts 1-2 years, but sometimes it can be very short (several days or weeks) or last for several years. There are frequent cases of exceptionally rapid change of voice: a boy who spoke the day before in a child’s voice suddenly reveals the voice of an adult man. In children who were sick a lot in childhood and who are poorly physically developed, puberty is delayed. At the same time, the vocal apparatus also lags significantly behind in development. In these cases, the voice may remain infantile for a long time, even at the age of an adult man.

The reasons for the change in voice during the mutation period are considered to be a violation of the coordination of the function of the external and internal muscles of the larynx and a lack of coordination between breathing and phonation. During this period, singing children experience a slight deepening of their voice, a slight narrowing of its range; high notes, which were previously easy to hit, are difficult to hit. The vocal folds may thicken, turn red, and have an abundance of mucus on them. This is manifested by hoarseness of varying degrees of severity, rapid fatigue of the voice, and the occurrence of unexpected breakdowns in the voice when singing. In girls during the mutation period, pronounced voice changes are not often observed, in approximately 40% of cases. On menstruation days, it is better to exempt the fairer sex from singing. The practical experience of phoniatrists and vocal teachers has shown that most children during the mutation period can sing. However, this requires strict adherence to the “protective regime” - it is not recommended to use the repertoire of adult singers. You should not practice singing if there are obvious changes in your voice. And, most importantly, we must remember that teenagers who study vocals need an experienced and attentive teacher.

The doctor will help you

Childhood and adolescence are characterized by instability of the nervous system. And it’s no secret that the post-mutation period is characterized by special vulnerability. At this age, the vocal apparatus quickly “gets tired.” Excessively loud singing, shouting, non-compliance with the age range - singing “adult” songs, solo performances on stage, singing during a respiratory illness, all this can lead to significant voice disorders and the development of diseases such as nodules, polyps and cysts of the vocal folds, chronic laryngitis, submucosal hematoma of the larynx, hemorrhage into the vocal fold.

Children with high temperament, who are said to not sit still for a minute, talk a lot, scream, and often suffer from vocal fold nodules (“screamer’s nodules”). By evening, their voice “sags”, becomes hoarse, and the child speaks in a whisper. Stressful situations, fright, fear, anxiety, especially in girls, can cause psychogenic aphonia. Various diseases of other organs contribute to the occurrence of voice disorders in children: rhinosinusitis, pharyngitis, tonsillitis, hearing loss, chronic bronchitis and tracheitis, diseases of the cardiovascular system, endocrine diseases.

Any voice disorder, especially one that persists for a long time, requires a thorough examination of the child. This requires consultation with an otorhinolaryngologist-phoniatrist with a mandatory examination of the larynx. At the OKDC, various methods are used for such diagnostics, ranging from simple laryngoscopy using a laryngeal mirror to optical endoscopy of the larynx.

Optical endoscopy of the larynx can be performed either with a rigid endoscope or with a fiberscope. Both methods are highly informative. However, only laryngeal stroboscopy can reveal the smallest changes in the vibrator activity of the vocal folds, which is very important in singing children, especially during the period of mutation.

During a stroboscopic examination of the larynx (a special examination of the larynx in pulsed light mode) during phonation (pronouncing or singing vowel sounds), vibrations of the vocal folds become visible, which makes it possible to clarify the nature of voice disorders. It is possible to examine the larynx using these methods from the age of 7-8 years, due to the emotional and behavioral characteristics of the young patient. At an earlier age, such a procedure can only be performed under general anesthesia, under light anesthesia, which is safe for the body.

Everyone knows that any disease is easier to prevent than to treat. The same can be said about voice disorders. Studies have shown that singing has a beneficial effect not only on the larynx, but also on the child’s body as a whole, and on his intellect. But the repertoire must be correctly selected in terms of range, the text is understandable for the child, and the duration of singing lessons should not exceed 30-45 minutes.

To prevent persistent voice disorders in a child, it is necessary to maintain vocal hygiene, sanitize foci of chronic respiratory tract infection, and if a voice disorder appears in the form of hoarseness, roughness or hoarseness, timely contact a phoniatrist.

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Types of aphonia known to medicine

The main classification of the disease involves dividing it into four types:

true, laryngeal aphonia;
paralytic;
hysterical or functional;
spastic.

True loss of voice is formed against the background of diseases and functional pathologies of the larynx, which make it impossible for the normal functioning of the vocal cords, their full correct closure and vibration - tumors, scars. Improvement in a person in this case can only occur if the root cause is eliminated.

The paralytic form of the disease occurs due to dysfunction of the inferior laryngeal nerve, which is responsible for the control, functioning and performance of most of the internal muscles of the larynx. Paresis or paralysis of the nerve can occur as a result of mechanical damage, trauma, surgery on the thyroid gland, due to compression of the aorta by a formed aneurysm, as well as due to the presence of tumors in the lungs, mediastinal organs, thyroid gland, trachea, esophagus. A possible cause of nerve paralysis is its toxic damage, not associated with its physical infringement or damage.

Functional aphonia is the result of the formation of an acute state of neurosis in a person, while there are no objective pathological changes in the larynx. When trying to cough up or when there is an irritating mechanical effect on the larynx, the patient develops a sonorous cough.

Spastic loss of voice is associated with spasm of the internal muscles of the larynx. As a result, the glottis narrows and the person cannot control the vocal cords. There may be several reasons, for example, mental trauma or irritation of the mucous membranes with caustic chemicals and vapors.

In addition, aphonia can be complete or partial. Complete loss of voice is observed with pharyngitis with complications, with laryngitis, in people who sing unsystematically for a long time “on chords”, without support. In this case, a person cannot extract any sound from his cords at all; he only has the ability to whisper.

With a cold, tracheitis, or sore throat, partial loss of voice is possible, when instead of a normal, deep and full sound, a person speaks with hoarseness and hoarseness, lower and duller than usual, but at the same time the ability to extract sound from the cords, albeit distorted, is present.

If voice loss occurs, for example, due to mechanical damage to the ligaments that cannot be corrected, it is considered irreversible. Basically, aphonia is temporary if, under certain conditions, the voice can return to the person.

Loss of voice due to laryngitis

Laryngitis is a disease that is more common in children and means an inflammatory process of the mucous membrane of the larynx. Laryngitis can occur for the following reasons:

infectious lesion;
overheating or hypothermia;
overstrain of the laryngeal muscles.

Adults can also develop such a lesion, however, due to the fact that the lumen of the larynx in an adult is somewhat larger than in a child, it occurs in milder forms.

Laryngitis can be:

catarrhal (the simplest form with typically infectious symptoms - high fever, dry cough, hoarseness in the voice);
stenotic (a form that is accompanied by a significant narrowing of the lumen of the larynx);
hypertrophic (in this case, a person has a strong hoarseness in his voice, and there is a high probability of complete aphonia);
atrophic (occurs in adults due to thinning of the laryngeal mucosa);
hemorrhagic (develops in parallel with toxic flu or blood diseases, accompanied by a dry or wet cough with blood);
diphtheria (the disease in this case passes from the tonsils to the larynx, a white bacterial coating forms on the mucous membranes);
purulent (rare, develops from catarrhal laryngitis, characterized by a sharp increase in all symptoms).

Laryngitis is always accompanied by hoarseness or complete loss of voice. In addition, the patient feels a sore throat, difficulty swallowing and breathing, hyperemia and redness of the pharyngeal mucosa, a “barking” cough, dryness and soreness in the mouth and throat, and spastic contraction of the muscles of the larynx. The condition resolves against the background of an increase in body temperature to 38-38.5 degrees.

It is more difficult to determine laryngitis in newborn babies than in older children, since infants cannot complain about how they feel. If the baby has become atypically capricious, restless and lethargic, has wheezing when crying, breathing is difficult and is accompanied by noise and whistling, if the child is coughing and has a runny nose with copious discharge from the nose, these signs may indicate laryngitis. The disease can occur without fever, so it is not worth relying reliably on this sign.

The disease and its inherent loss of voice should not cause panic - if you consult a doctor in time, follow all his recommendations and treatment instructions, the inflammation will soon stop and the voice will be restored.

Loss of voice due to nervousness: how and why it happens

Can a person be left without a voice due to nervous experiences, stress or neurosis? Aphonia, as well as some other phonetic pathologies, may be of a psychosomatic nature.

Approximately 20% of people with anxiety-depressive spectrum disorders experience voice problems or loss of voice. Most often, aphonia is associated with hysterical neuroses and a general anxiety-depressive state. Women, especially during pregnancy, are more susceptible to nervous loss of voice than men, since their psyche is somewhat less stable.

Hysterical states can lead a person to functional aphonia, when a normal, loud, sonorous voice is absent, but whispered speech is preserved. In this case, voice impairment or loss occurs suddenly, against the background of good physical well-being. A person complains of a feeling of a lump in the throat, a buildup of phlegm, which seems to interfere with speaking. The pathology may suddenly go away on its own, but if the voice disappears for no apparent physiological reason, it is better to visit a doctor.

Lung diseases and aphonia: how they are connected

Bronchitis is an inflammatory disease that affects the bronchi, causing mucus and even pus to form and secrete on their mucous membranes. Bronchitis mainly develops as a complication of untreated infectious diseases (influenza, ARVI), after a cold suffered “on the feet,” as well as as a result of allergic reactions. In the absence of proper treatment, it can be complicated by pneumonia or develop into bronchial asthma.

The clinical picture of the course is very characteristic - first of all, the patient begins to suffer from a cough. It may be dry or moist and may contain sputum and pus. In addition, a person’s body temperature rises, he feels general malaise, increased fatigue and weakness, and has a sore throat. Chronic forms proceed similarly, but more often without an increase in body temperature.

Often the cough has a “barking” character and intensifies during sleep. If the cough is very severe and the vocal cords are overstrained, the patient may experience aphonia. Loss of voice is also possible if bronchitis develops as a complication of pharyngitis or laryngitis.

There is no direct connection between the processes in the bronchi and aphonia, but impaired respiratory processes and cough due to inflammation of the bronchi can temporarily deprive a person of his voice.

Lung cancer ranks one of the first among all types of cancer in terms of incidence. Primary lung cancer is more common in men and tends to develop against the background of chronic lung diseases - bronchiectasis, chronic bronchitis, as well as due to occupational lung diseases associated with constant inhalation of irritating and dangerous particles (dust, various chemicals). Smoking is one of the determining factors for the development of the disease.

The development of lung cancer occurs gradually, so it is difficult to determine the exact moment of its onset. The tumor is usually located inside the bronchus, gradually closing its lumen, causing atelectasis to form. The neoplasm can metastasize and penetrate into other areas, for example, the pleura and lungs. At the same time, the person feels dull pain in the chest, he is tormented by attacks of coughing, first dry, then wet with blood. The cough gradually acquires a whistling, “barking” sound. Over time, fever and chills may occur. Upon examination, the doctor notices dilation of the subcutaneous veins in the chest area, enlarged lymph nodes, and slight swelling of the subcutaneous tissue in the neck. The lung affected by the disease is somewhat behind the healthy inhalation rate.

Can the voice disappear? Aphonia does accompany the development of lung cancer in some cases, but it cannot be considered a constant and reliable sign of pathology. Loss of voice is present in the patient if the tumor grows into the mediastinum area and provokes compression of the nerve trunks, large vessels and esophagus. Along with aphonia, there is a swallowing disorder and obvious swelling of the lower half of the face.

Diagnosis of voice disorders

The most accurate diagnosis for voice disorders can be made by a doctor based on medical history, examination and some other types of research.

Diagnosis may require indirect laryngoscopy using a mirror and a forehead lamp. If this procedure does not give the desired result, it can be performed using a flexible fiberoptic laryngoscope. This procedure is performed under local anesthesia. In case of acute inflammation of the larynx, the patient can see redness of the larynx without the presence of discharge. Using this study, benign and malignant tumors of the larynx can also be detected.

If the laryngeal nerve is injured, the patient may experience vocal cord paralysis on one side. If this pathology is detected, the doctor must conduct an additional examination to identify the factors that provoked this condition.

When examining the neck, the doctor must rule out the presence of a goiter. If the supraclavicular lymph nodes are detected to be enlarged, the doctor may suspect the patient has tumors in the esophagus.

During an examination of the chest organs, the specialist must exclude the patient from collapsing lung lobes and inflammation of the pleura, which often accompanies lung cancer.

In some cases, it may be necessary to conduct laboratory and instrumental studies, which include:

ESR - performed for inflammation of the larynx, neoplasms;
RGC - for malignant lung tumors;
tensilone test - for patients with autoimmune neuromuscular diseases;
computed tomography of the cervical spine - prescribed for patients with laryngeal or thyroid cancer to determine its stage;
computed tomography of the chest - performed for tumors in the lungs, an increase in the diameter of the thoracic aorta;
endoscopy - prescribed for suspected esophageal cancer;
aortography of the aortic arch;
OAC - prescribed to patients with inflammation of the larynx;
biopsy - for thyroid tumors.

Some patients are recommended to be additionally examined by a phoniatrist and a neurologist.